Community-based management of acute malnutrition: Implementation quality, and staff and user satisfaction with services.

Background: Malnutrition is a problem that affects many children and therefore is the focus of multiple interventions worldwide. One intervention is community-based management of acute malnutrition (CMAM). Objective: This study assessed CMAM implementation quality in the Builsa North District of Ghana, and the satisfaction among both users and CMAM staff. Design: The study used a convergent mixed-method design involving in-depth interviews with CMAM staff and users, document reviews, and observations of the CMAM implementation. The data were collected across eight health care facilities in eight sub-districts. The data were qualitatively and thematically analysed in Nvivo software. Results: Several factors were found to adversely affect the quality of CMAM implementation. Significant factors included inadequate training of CMAM workers; religious belief systems; and a lack of implementation materials, such as ready-to-use therapeutic food (RUTF), CMAM registration forms/cards, and computers. These factors adversely affected programme quality, thus resulting in dissatisfaction among CMAM users and staff. Conclusion: This study established that the CMAM programme in the Builsa North District of Ghana is hindered by a lack of primary resources and logistics necessary for successful programme implementation. Most health facilities in the district lack such resources and are not delivering the intended results.